Prague C and M Classification for Barrett's Oesophagus
Standardised endoscopic description of Barrett's oesophagus extent. C = circumferential extent (cm above GOJ); M = maximum extent (cm above GOJ). Used for surveillance interval determination and dysplasia reporting. BSG 2023 and NICE NG12 guidelines use Prague C&M to guide surveillance intervals. Short-segment Barrett's: maximum extent below 3 cm; long-segment: 3 cm or above.
Score interpretation
Below the ≥ 1 cm definition.
→ No Barrett's surveillance.
With intestinal metaplasia: surveillance every 3–5 years (BSG; NICE NG231).
→ Without intestinal metaplasia: repeat endoscopy with quadrantic biopsies; discharge if still absent.
Surveillance every 2–3 years (BSG; NICE NG231); consider a specialist centre if > 10 cm.
→ Tailor the interval to risk factors.
Dysplasia cannot be excluded.
→ Optimise acid suppression and repeat endoscopy with biopsies (BSG: within 6 months).
Low-grade dysplasia, high-grade dysplasia or intramucosal carcinoma.
→ Refer to a specialist Barrett's MDT for confirmation by a second pathologist and endoscopic therapy.
Interpretation bands for the Prague Barrett's. Apply clinical judgement and local guidance.
References
- Sharma P et al. The development and validation of an endoscopic grading system for Barrett's esophagus: the Prague C and M criteria. Gastroenterology. 2006;131(5):1392-1399.
- BSG Guidelines for the Diagnosis and Management of Barrett's Oesophagus. British Society of Gastroenterology. 2023.
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